Naturopaths’ options expanded Prescription of many drugs are now allowed November 2, 2007

BELLINGHAM — Naturopathic physicians can now prescribe many drugs previously off-limits to them, thanks to changes in state law lifting several practice restrictions.Some naturopaths say the new rules will make it easier for patients — and their insurance companies — to make naturopaths their primary care physicians.

Department of Health rules that take effect today allow naturopaths to write prescriptions for many drugs, except for the most abuse-prone ones that have stricter regulations. They may also provide intravenous medications and, if they get approval from the Drug Enforcement Agency, can prescribe medicines made from the controlled substances of testosterone and codeine.

Until today, the state’s naturopaths were mostly restricted to prescription and nonprescription medicine derived from natural substances such as plants, animal organs and minerals, injections of vitamin B-12, prescription topical antiseptics and homeopathic remedies.

It’s the state’s biggest expansion in the allowable practice of naturopaths in about 20 years, further narrowing the gap between the kind of care provided by medical doctors and by naturopathic physicians.

“If we have a DEA number, we’re able to prescribe most of what medications other medical doctors have prescribed for them,” said Maria Putney, a Bellingham naturopath.

“Drugs for hypertension, cardiovascular ailments, depression, are all drugs that we’re going to be able to prescribe,” she said.

But most probably won’t, say naturopaths, who typically emphasize natural remedies and nutrition in their practices.

“Most of us went to school to be naturopaths because we don’t want to use these drugs,” said Douglas C. Lewis, president of the Washington Association of Naturopathic Physicians. “I don’t expect there to be suddenly a lot of naturopaths writing prescriptions for things they never wrote before.”

The change means patients taking drugs for chronic conditions like diabetes or high blood pressure won’t need to shuttle between a medical doctor and a naturopath for their medication.

“If a patient comes in and really needs an inhaler for the treatment of asthma, I can prescribe it now,” said Lewis, who practices in Seattle. “I don’t have to send them off for another doctor visit.”

And it will be easier to work with patients who want to try naturopathy for their chronic conditions, Putney said. It’s unethical to advise a patient to stop taking a medicine prescribed by another doctor, she said, but making the transition to a different treatment plan is easier with one doctor writing the prescriptions.

Putney said most of her patients also have a medical doctor as a primary care physician, and many M.D.’s share notes with her on the patients they have in common.

“Most doctors seem to be open to the idea,” she said, “at least locally, that I’ve encountered.”

Insurance companies vary widely in how and whether they cover naturopathic physicians. Many treat naturopaths as specialists, covering treatment only with a referral from a primary care physician. Others provide a limited number of visits to naturopaths.

The state Legislature passed a law in 2005 that expanded the practice rules, but it took until recently for the Department of Health to finalize the regulations.

The process included researching what naturopaths learn in naturopathy school, said Susan Grag, manager of the program, and looking at other states that already allow them to prescribe these drugs.

Washington is one of about 14 states that license naturopaths, Grag said, and is one of the least restrictive of their practices. Some states don’t allow naturopathic physicians to practice at all.

The state licenses naturopaths who have completed doctoral programs at one of four naturopathic schools in the country, including Bastyr University in Kenmore and National College of Naturopathic Medicine in Portland, Ore. They must also pass exams covering science, diagnosis, emergency medicine and diagnostic imaging.

Putney, who opened a practice in Bellingham earlier this year, said she studied intravenous drug therapy during her coursework in Portland, and she’ll be able to offer that in her practice under the new state regulations.

And testosterone-based drugs might be useful for women going through menopause, she said. But she doesn’t see herself prescribing many codeine-based medications.

“I think botanical medicines and clinical nutrition and homeopathy does a better job at addressing things that are going on than using pharmacological drugs,” she said.